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REAL WORLD RECOVERY

Many times patients, employers, rehab nurses, athletes, coaches, and insurance companies have unrealistic expectations in regards to rehabilitation recovery times. It falls to the physical therapist to explain the healing and recovery “time line.” These guidelines are applicable to the patient who undergoes a rotator cuff repair, lumbar fusion, tibia plateau fracture, humeral head fracture, etc… Understanding the duration and the level of effort required to fully regain function can keep a patient focused and eliminate disappointment.

Recovery Reality
If you have systemic health issues such as rheumatoid arthritis, diabetes, etc…. your recovery will take longer. The older you are, the longer your recovery will take. That professional athlete who went back to basketball, three weeks after a knee arthroscopy—he is 24 years old and you are 48 years old. It is going to take you much longer. The weaker you are at injury onset, the longer your recovery will take. If this is a second, third, or fourth injury of the same joint—the recovery will take longer.

Consistency is king in recovery. The individual who follows the program and performs the work will recover sooner. Many patients want to order off the rehab menu—I will have this and this but none of that. In these cases, recovery will take longer and be less effective.

You will probably have to work on more than your injured / post surgical joint during your recovery. The body is an interconnected machine and weakness / limited movement in one area can create the tissue breakdown in other areas. The post ACL repair patient often needs extensive strengthening of the hip. The shoulder pain patient will have to address postural issues in the neck.

Very often you have to change your lifestyle during the recovery period. Yoga after a back surgery may be on hold for nine months. Road running after a surgical repair of your ankle can be off the program for up to a year. After a reverse total shoulder replacement, you may not be able to chop firewood for twelve months.

Progress is never linear. You have good days and bad days—this is normal. You feel and move better for three or four therapy sessions and then you have a few sessions of greater symptoms and more limited function. Do not collapse, despair, call the president–stay with the program and realize that time is on your side.

TIME LINES

Onset – Three Months
This is the in the physical therapy clinic rehabilitation phase.

The inflammatory phase of the injury / surgery resolves.

Active and passive movement of the joint improves.

Depending on the injury / surgery, pain resolution occurs later in this phase.

A protocol of rehabilitation activity may be in effect for certain surgical procedures.

Most patients have regained 60-70% of the function at the end of three months.

People with sedentary work can return to their occupations. More strenuous occupations will require further conditioning.

Three – Six Months
You exercise three or four times a week. Ideally, you visit the physical therapist for progressions of the training program.

You can expect some level of discomfort. The post surgical shoulder will still not feel like the non surgical shoulder. The lower back will have days of stiffness. These episodes are normal and part of the recovery process.

Strength is still limited and you will have to work on corrective exercises for the next three months. Resist the temptation of an early return to your Olympic lifting, Warrior Run, or Zumba class.

Individuals with strenuous occupations undergo a work conditioning program.

Most patients have regained 85-90% of their function at the end of six months.

Six – Nine / Twelve Months
This is the point that most people stop all formal rehab exercise activity.

The more active you are and the more demanding your lifestyle the more you need to continue to train through this phase.

I personally believe this is the most important recovery phase for spinal patients. You never completely recover from a spinal injury—you actively manage the problem.

I encourage everyone to work with a trainer on your fitness program. Exercise is like medicine. Take the proper dose for your specific problem and the results are magic.

The focus of your training should be to get stronger.

Nine / Twelve Months – Death
Consistent maintenance of the machine that carries you through life can dramatically improve the quality of that existence.

The biggest predictor for a future injury is a prior injury. Stronger individuals are less likely to get injured and have to travel back through the nine month rehab process.

Michael S. O’Hara, PT, OCS, CSCS

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